Eczema can truly be a real pain in the ass for those who suffer with it. And unfortunately for us a large part of the population suffers from it in one way or form, with very few finding remedies or solutions to keep it under control. This can often mean taking extra precautions and planning ahead to avoid an irritation or flare-up.
People who don't suffer with it don't really understand to what point it can be a disruption to your life. The “itch-scratch cycle” is about as vicious as they come, and anything that induces it has the full capability to bring almost unbearable discomfort.
Eczema is actually a general term to describe varying skin conditions that result in inflamed and discolored skin. Typically the skin is red, dry, inflamed, and occasionally blisters or crusts form. The most common type is atopic eczema, thought to be hereditary and triggered by allergens. Atopic eczema is most common in children, but can reappear during adult years. There is no cure, but figuring out what causes it to flare up and treating the symptoms is usually the course of action to take.
If you have eczema, your skin is most likely producing less fats and oils than it should be, and the ability to retain water is diminished. The space between cells widens since they aren’t plump with moisture, you begin to lose water from the dermis, and irritants and bacteria can enter easier. This is why things like soaps and detergents can worsen eczema, as they strip away the lipids of your skin, causing it to breakdown faster than healthy skin would, becoming dry, inflamed, and sometimes cracked or blistered.
If you are a sick and tired sufferer, below I have outlined a 3 step process to making everyday a little bit more manageable.
1. Bathing and moisturizing
Bathing actually allows moisture to enter into the skin. Immediately following your bath you can lock in this moisture with an intensive layer of moisturizing cream. Previously, doctors often recommended that eczema sufferers limit baths and showers; however, experts now recommend bathing as an important part of controlling eczema.
After bathing, gently pat the skin dry, and then immediately apply your moisturizer to skin that is still damp. Apply prescription products, as recommended by your doctor. Apply a moisturizer several times throughout the day. Moist skin will reduce itchiness, which in turn helps to control the disease, as flares occur or increase in response to itching. Frequent bathing (even 2 to 3 times daily) followed by a moisturizer should be your first defense in managing eczema and flares.
Steps by step guide:
- Fill the bath with lukewarm water (add some emulsifying oil if you choose). The skin will absorb some of the water (and oil if you add it).
- Immerse yourself in the water, trying to cover as much of the body as possible, with the exception of the head in water. If eczema is on the face, or areas of the body not soaking in the water, gently apply a soft wash cloth soaked in the water/oil mixture to those areas. Soak for at least 5 minutes but not longer than 20 minutes.
- Use a gentle cleanser on areas of the body that need additional cleaning.
- Gently dry off excess water with a soft towel, or briefly air dry if the air is warm. You may leave the skin slightly damp.
- Next, apply your medications, exactly as prescribed by your doctor. If your medicated treatment contains a corticosteroid (e.g. Hydrocortisone, Fucidin H), you would typically apply now to the still damp skin. For the non-cortisone based prescriptions, such as Elidel or Protopic ensure the skin is completely dry before applying.
- When applying prescription products, carefully avoid the healthy skin.
- Apply your moisturizer to the remaining patches of healthy skin. The entire body can and should be moisturized between bathing with your regular, non-prescription moisturizer. If most of the skin is covered in eczema, use your prescription products after the bath, and then apply a coat of moisturizer to the whole body at least 30 minutes after the prescription products.
2. Prescription treatments to reduce inflammation and bacteria
Medical management is an important part of controlling eczema, and medications should be used as prescribed by your doctor. Speak to your doctor about the best treatment option for you as an individual. Medical management includes all the outlined options below:
Anti-inflammatory topical treatments:
Topical Corticosteroids are prescribed to reduce inflammation and itching. Strengths range from mild to very strong. When used under the direction of a physician, topical corticosteroids are very effective and safe. However there are possible side effects include thinning of the skin if preparations are used excessively or for extended periods.
Topical Immunomodulators (e.g. Elidel, Protopic) are prescribed for inflammation and itching, and can be used for short, intermittent periods of time unless otherwise directed by your doctor. A possible side effect is a mild to moderate burning sensation.
Topical Antibiotics are prescribed for secondary infection, which can worsen the eczema and may make it more difficult for the eczema to respond to treatment until the bacterial infection has been cleared. Localized patches of infected or resistant eczema may be treated by topical antibiotic creams and ointments. Mupirocin (e.g. Bactroban) or fusidic acid (e.g. Fucidin ointment) have shown to be beneficial.
Combination Topical Treatments (e.g. Fucidin H) combine Fucidin with a mild hydrocortisone, which helps to both reduce inflammation and clear the secondary infection with one application. Clearing infections is an important part of eczema management.
Oral Antibiotics are prescribed for more significant skin infections. There is often a secondary infection on eczema patches, even when there may be no other obvious signs of infection. Oral antibiotics are preferred over topical antibiotics when the infection is extensive.
Skin Barrier Repair Emulsion:
EpiCeram is a new non-steroid barrier repair emulsion that is safe to use at all ages. EpiCeram is a therapeutic skin barrier repair emulsion which has a unique composition of key lipids (fats) that are recognized to be lacking in the skin of many patients with atopic dermatitis (eczema). When compared head-to-head with a mid-potency topical steroid, it was shown to have similar benefits in improving eczema. Of course speak to your doctor about this treatment.
Oral Corticosteroids (e.g. Prednisone ) are rarely used, and reserved for the most severe cases. There are long-term side effects with prolonged use, and because eczema is a chronic condition, this is not a permanent solution for severe chronic eczema.
Antihistamines are used to relieve itching and aid in sleep. Itching tends to increase at night (daytime distraction also helps reduce daytime itching). As you increase hydration of the skin (through bathing and regular moisturizing) and manage your eczema, you will decrease the need for antihistamines, as night time itching decreases when the skin is moist and healthy.
Oils such as coconut and jojoba have been proven to be great natural alternatives, to the point where I would recommend trying these first where and when possible.
3. Trigger avoidance to reduce flare ups
This might actually be the hardest of the 3 steps. Firstly because you need to be extremely aware of your environment and ready to note and analyze every situation and flare up as and when it happens. Secondly because once you have realized what triggers it, you need to avoid it as much as possible. And as we all know if it is something enjoyable it's not going to be easy.